Report of Renewable Hydrogen Dispensed

Attachment 7 Report of Renewable Hydrogen Dispensed Agreement Number: ______Recipient Name: ______Reporting Period: ______Station Location: ______

Percentage Renewable Hydrogen Dispensed:

Source of Renewable Hydrogen: ______ Biomethane or biogas such as: biomass, digester gas, landfill gas, sewer gas, or municipal solid waste gas.  Other feedstocks may be eligible if the Application demonstrates that the proposed feedstock is sustainably produced, reduces greenhouse gas (GHG) emissions compared to the petroleum baseline, and achieves the ARFVTP sustainability goals contained in 20 CCR 3101.5.

 Eligible renewable electricity sources include facilities that use the following:

 Fuel cells using renewable fuels

 Geothermal

 Small hydroelectric (30 megawatts or less)

 Ocean wave

 Ocean thermal

 Tidal current

 Photovoltaic (PV)

 Solar Thermal

 Wind

 Biomass digester gas

 Municipal solid waste conversion (non-combustion thermal process)

 Landfill gas

 Renewable Energy Certificates (RECs)

 Other as approved by CAM Description:______Date approved by CAM: ______CAM signature:______Renewable source split if multiple sources were provided:

of 1 GFO-17-601 L-D Vehicle Hydrogen Refueling Infrastructure 8/2017 Operation and Maintenance Support Grants Attachment 7 Report of Renewable Hydrogen Dispensed Source: ______Percentage:

Source: ______Percentage:

Add additional pages as necessary. Attach documentation of all renewable hydrogen or electricity sources.

Recipient Signature: ______Date: ______

of 1 GFO-17-601 L-D Vehicle Hydrogen Refueling Infrastructure 8/2017 Operation and Maintenance Support Grants